Prescribing Flashcards
Definition
What is “adherence”?
The extent to which the patient’s behaviour matches agreed recommendations from the prescriber
This has been changed from “compliance” as it presents the role of the patient as a passive recipient. Non-compliance may be interpreted as incompetence on the part of the patient or the patient willfuly engaging in harmful behaviour
What is “concordance”?
A process of prescribing and medicine-taking based on partnership
What are the five dimensions that affect adherence, as defined by WHO?
Social/economic factors
Health systems/healthcare team factors
Therapy-related factors
Patient-related factors
Condition-related factors
Give an example of a social/economic factor that affects adherence
Age, sex, inability to pay for medicines
Give an example of health system/healthcare team factors that may affect adherence
Poor quality instructions provided to the patient
Give an example of therapy-related factors that may affect adherence
Adverse effects, complex drug regimens
Give an example of patient-related factors that may affect adherence
Patient disagreeing with necessity of treatment, low self-esteem
Give an example of condition-related factors that may affect adherence
Dysphagia in myasthenia gravis
What is a subjective strategy for measuring medication adherence?
Assessing adherence based on patient’s self-report
Common prescriptions
What dose and route of adrenaline should be prescribed in acute anaphylaxis in an adult?
500 micrograms IM
Drug allergies
In allergic drug reactions, what mediates the symptoms?
Histamine release from mast cells.
Mast cells are activated either by IgE or directly by the drug
Drug allergies
What are the symptoms of a Type 1 allergic drug reaction?
Urticaria, itching, angioedema, bronchospasm and hypotension
Drug allergies
How soon after administering the drug do the symptoms of an allergic reaction occur?
30 minutes (up to 2 hours), may not be after the first dose of the drug
Parenterally administered drugs have a median time to cardiac arrest of 5 minutes from the first symptoms in extreme reactions
Drug allergies
What should you do after a patient has presented with a serious allergic reaction to drugs (after managing them)?
Report to the Yellow Card Scheme
Which class of drugs is well-known to exacerbate asthma?
NSAIDs
Which of these antibiotic classes should you avoid in a patient with a penicillin allergy?
- First generation cephalosporin (cefalexin)
- Second generation cephalosporins (cefuroxime)
- Third generation and subsequent cephalosporins (ceftriaxone, cefotaxime)
- Carbapenems (doripenem, ertapenem, meropenem)
- Monobactams (aztreonam)
Avoid cephalosporins and carbapenems
How long should a patient be observed for after an anaphylactic reaction?
6-12 hours
A patient has an allergic drug reaction to an ACE inhibitor. What should you do about this prescription?
Switch to an angiotensin-II receptor antagonist
List the risk factors for developing an allergic reaction to drugs
Atopic individuals
Co-existing conditions (HIV, EBV, CMV and cystic fiborisis)
Chronic urticaria or mastocytosis (NSAIDs, opioids and other drugs with histamine releasing properties)
Drug dependant factors (beta-lactam antimicrobials, neuromuscular blocking agents, radiocontrast media, NSAIDs)
Frequent and prolonged doses
Sex - women more at risk
Topical application of drugs
What co-existing conditions are risk factors to developing a drug allergy reaction?
HIV, EBV, CMV and cystic fibrosis
In patients with chronic urticaria or mastocytosis, what drugs are they more likely to be sensitive to?
NSAIDs, opioids, other drugs with histamine releasing properties (e.g., atracurium)
What drugs are more likely to result in an allergic reaction?
Beta-lactam antimicrobials, neuromuscular blocking agents, radiocontrast media, NSAIDs, high molecular weight starches
What should you prescribe for a mild-moderate drug allergic reaction in an adult?
Chlorphenamine 4mg PO
What two drugs should you prescribe for a patient who is being discharged after a moderate/severe anaphylactic reaction to a drug?
Prednisolone for up to 3 days
Non-sedating antihistamine for up to 3 days
